Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, precertification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.
On October 11, 2022, for dates of service on or after August 31, 2022, the Texas Medicaid & Healthcare Partnership (TMHP) will implement reimbursement rates for COVID-19 vaccine administration procedure codes 0124A and 0134A (Pfizer and Moderna COVID booster vaccines) for Texas Medicaid, Healthy Texas Women (HTW), the Family Planning Program (FPP), and the Children with Special Health Care Needs (CSHCN) Services Program.
Any affected claims that are identified will be reprocessed. Providers are not required to appeal the claims unless the claims are denied for additional reasons after reprocessing is completed.
To view the updates, click the following link: COVID-19 Vaccine Administration Procedure Codes 0124A and 0134A
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.